胆管闭锁与十二指肠乳头异位的关系探讨

目的 胆管闭锁的病因目前尚不清楚,本研究对胰胆的解剖进行造影研究.方法 对221 例胆管闭锁患儿中 47 例(21.3%)进行胆管造影,根据胆囊管和胆总管及十二指肠显影清晰影像进行研究,观察胆总管、胰管、胰胆合流共同管及其开口部位.以同期收治的 29 例非胆管闭锁性黄疸婴儿的胆管造影结果 为对照.结果 对照组29例中7例(24.1%)十二指肠乳头开口于十二指肠降段以远,而胆管闭锁组 47 例中 24 例(51.1%)十二指肠乳头开口于十二指肠降段以远,后者较前者明显增高(P<0.05).胆管闭锁组和对照组合并胰胆合流异常的发生率分别为95.7%(45/47)和82.8%(24/29),二者差异无显著性意义(P>0.122).胆管闭锁患儿胰胆合流共同管的平均长度指数为0.418±0.152,比对照组(0.236±0.122)明显延长,P<0.05.胆管闭锁组胆总管的平均直径指数为0.078±0.043,对照组为0.199±0.086,前者较后者明显细小,P<0.05,而共同管和胰管的直径差异不显著(P>0.05).结论 十二指肠乳头远端开口异位和胰胆合流共同管延长是胆管闭锁影像学改变特点,提示此畸形的病因与胚胎早期肝憩室发育异常有关.

Ectopic papilla of vater in biliary atresia

Objective The etiology for biliary atresia (BA)is still unkown. The aims of this study was to investigate the relationship between the size and location of pancreaticobiliary ducts and biliary atresia. Methods this study was carried out in 47 patients with biliary atresia who had cholan- giography. Twenty-nine neonates with persistent jaundice were used as controls. In order to excluded variations in magnification and age between studies, Length index (the ratio of the common channel length to the height of the second lumbar vertebra) was adopted to eliminate the age factor. Results In the control group,24.1% (7/29)the papilla of Vater was located distal to second portion of the duode- num,however 51.1% (24/47) of the patients with biliary atresia had the papilla of Vater distal to the second portion of the duodenum. The ratio of ectopic papilla of Vater was significantly higher in BA patients than in controls (P<0.05). The incidences of pancreaticobiliary malunion (PBMU) in BA and control groups were 95.7%(45/47) and 82.6% (24/29) respectively,and the difference was not sta- tistically significant with P>0.05. The length indices of the common channel in BA and control groups were 0.418 ± 0.152 and 0.236 ± 0.122 respectively, the former was significantly longer than in latter (P<0.05). The average diameter of the common bile duct in BA was significantly smaller than in con- trol (0.078 ± 0.043 versus 0.199 ± 0.086, P<0.05). Conclusions The high incidence of ectopic papil- la of Vater and the longer common channel in BA patients suggest that over-growth of the hepatic di- verticulum during early embryonic development may be an important etiologic factor for BA.